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General NPI Number Information
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NPI Number | 1598320749
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Entity Type | Individual
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Provider Name | LAUREN MICHELLE JACKSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1136 S DELANO CT W APT 707
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City | CHICAGO
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State | IL
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Zip | 60605-3738
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Country | US
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Telephone | 847-440-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 308 E 25TH PL
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City | CHICAGO
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State | IL
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Zip | 60616-5500
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Country | US
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Telephone | 847-440-4330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180014672
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License Number State | IL
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